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General NPI Number Information
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NPI Number | 1114175304
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Entity Type | Organization
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Legal Business Name | SENTARA MEDICAL GROUP
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 2000 MEADE PKWY
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City | SUFFOLK
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State | VA
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Zip | 23434-4259
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Country | US
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Telephone | 757-934-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 MEADE PKWY
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City | SUFFOLK
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State | VA
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Zip | 23434-4259
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Country | US
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Telephone | 757-934-9300
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ARRIE P HINES
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Credential |
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Telephone | 757-252-3292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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